Problem: 59 yr old male who works as a roofer presents with bilateral knee pain. he was a high school athlete and had his ACLrepaired on his left knee 20 years ago he is currently obese and states the pain is worse going downstairs with activity and at night when sleeping he reports the pain is interfering with quality of life he denies any recent injuries and is just here to get something for pain he has not seen a provider for 5 years mph htn obesity medication lisinopril 10mg fault finding both knees slightly swollen without erythema or warm h no tenderness on palpating. drawer mcmurtry lachlan test negative the bulge and ballottement sign's negative mold non pitting edema ankle